Provider Demographics
NPI:1215113378
Name:KEMMERER, NICOLA A (PA)
Entity type:Individual
Prefix:MISS
First Name:NICOLA
Middle Name:A
Last Name:KEMMERER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:234-677-1193
Practice Address - Street 1:100 NW 170TH ST STE 208
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5510
Practice Address - Country:US
Practice Address - Phone:305-405-0045
Practice Address - Fax:305-405-0048
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA11757363A00000X
FLPA9104311363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAU165ZMedicare PIN